Cancer-related fatigue (CRF) is the most common and among the most debilitating symptoms and side effects of breast cancer and its treatment 1. CRF is different than other types of fatigue because it is persistent, doesn’t improve with rest and interferes with activities of daily life 2.
CRF can negatively affect your plans to return to work, relationships and quality of life after cancer treatment as it can persist for weeks or even several years 2.
There are many causes of CRF that can be difficult to untangle and therefore make CRF challenging to manage 3. Causes of CRF could include the cancer itself, cancer treatments, symptoms and side effects, medications, hormonal changes, pain, infection, depression, anxiety or anemia. CRF is becoming more common as cancer treatments become more intense and targeted and combine different types of treatments (such as chemotherapy and radiation together) 4. Speak to your oncologist about your fatigue to identify the potential causes and best strategies to help you.
Nutrition and CRF
Adequate nutrition is essential for maintaining energy levels, retaining muscle mass and preventing nutrient deficiencies. As such, nutrition can have a significant impact on fatigue.
Very little research has been conducted on nutritional strategies to manage cancer-related fatigue 5 6. As a result, many of the recommendations are based on addressing inadequate nutrient intake and malnutrition as contributors to fatigue. A registered dietitian specializing in oncology can help identify nutrition and lifestyle-related contributors to fatigue that could be worsening the effects of CRF.
Nutrition-Related Causes of Fatigue 7
- Skipping meals
- Unbalanced meals
- Not getting enough calories
- Not getting enough protein
- Nutritional deficiencies such as anemia (low levels of iron, folate and/or vitamin B12)
- Dehydration
- Nutrition-related side effects of cancer and its treatment (loss of appetite, nausea, diarrhea, etc.)
- Caffeine intake
- Alcohol intake
Nutrition Strategies to Manage Fatigue 7, 8
Choose balanced meals and snacks
Eat something every 3 hours or so to keep your energy levels up. Make sure each meal and snack contains a source of complex carbohydrates, protein and healthy fats to give you sustained energy.
For complex carbohydrates, choose whole grains, sweet potatoes and other fibre-rich foods (unless you are experiencing diarrhea, gas or bloating or feeling full quickly). They provide a steady supply of energy. White bread and white rice are refined grains. They give you a quick burst of energy but then make you feel tired afterwards. That’s why it’s best to have refined carbohydrates less often.
Sources of protein include fish, chicken, turkey, meat, dairy products, nuts, seeds, beans and lentils. Have a protein-rich food at all meals and snacks to keep your energy levels up and to preserve muscle.
Have some healthy fat such as avocado, olive oil, nuts or seeds with each meal and snack. This will give you a stable supply of energy and gives your meals staying power.
Get enough calories and protein
See a dietitian to help you determine the right amount of calories and protein for you.
TIPS TO ADD MORE PROTEIN TO MEALS AND SNACKS:
- Have a palm-sized serving of chicken, turkey, fish, lean pork or beef, 2 eggs or a fist-sized serving of beans at each meal
- Use Greek yogurt or blended cottage cheese as a dip for vegetables and fruit
- Add nuts or seeds to salads, cereal, yogurt
- Try nut or seed butters on wholegrain crackers or bread
- Make hard boiled eggs and add them to salads or have as part of snacks
- Add beans to soups, salads and pasta sauce or make a bean dip
- In smoothies, add nut butter, nuts or seeds, Greek yogurt, cottage cheese, soft tofu or pasteurized egg whites
Eat more fibre
Research suggests that getting at least 25 grams of fibre a day can help reduce CRF(6,7).
Fibre is found in whole grains, fruits and vegetables, beans, peas, lentils, nuts and seeds. To get more fibre, choose breads with at least 2-4 grams of fibre per serving and breakfast cereals with at least 4 grams of fibre per serving.
If you are experiencing diarrhea or bloating with fibre-rich foods, choose foods high in soluble fibre such as oats, psyllium, barley and bananas.
Eat the rainbow
Vegetables and fruit are excellent sources of phytochemicals, antioxidants and vitamins that protect your healthy cells, help fight cancer cells, turn your food into energy, lower inflammation and boost your immune system. They’re also rich in fibre which may help improve your energy levels (see above).
The colour of a vegetable or fruit is a clue to the type of phytochemicals it contains. To get the widest variety and all of the benefits of different phytochemicals, choose produce in as many bright colours as you can.
Choose healthy fats
Oily fish such as salmon, mackerel, trout, sardines and Arctic char are rich in omega-3 fatty acids. Omega-3s lower inflammation and may help improve your energy levels.
Stay Hydrated
Not drinking enough fluids increases fatigue. Most people need at least 8 cups (2 litres) of fluid each day.
Fluid is anything that is liquid at room temperature and includes water, juice, milk, smoothies, soup, broth, popsicles, frozen yogurt and tea. Speak to an oncology dietitian to find out how much fluid you need and which liquids are best for you.
Nutritional Deficiencies
See a registered dietitian to help identify whether you are getting all of the nutrients you need and to provide suggestions on how to increase your intake of any nutrients you might be lacking in. Your doctor can order blood tests to see if you are low in key nutrients such as iron.
Anemia
If your doctor has told you that you have anemia, this means that your body doesn’t have enough vitamin B12, folate or iron to make healthy red blood cells to deliver oxygen to your body’s cells.
Anemia can be caused by not getting enough of these nutrients in your diet or could be related to the cancer itself or cancer treatments. Your doctor might recommend supplements or prescribe medications or a red blood cell transfusion to bring your iron levels up.
TIPS TO GET MORE IRON, VITAMIN B12 AND FOLATE:
- Red meat, fish and poultry are rich in vitamin B12 and heme iron which your body absorbs best
- Some iron and vitamin B12 is also found in eggs, milk, and fortified milk alternatives
- Broccoli, spinach, lentils, peas, beans, oats, nuts & blackstrap molasses contain non-heme iron which your body absorbs half as well as heme iron. Your body will absorb non-heme iron better if you eat these foods with foods rich in heme iron (see above)
- Foods rich in vitamin C such as kiwis, citrus fruits, strawberries, tomatoes and bell peppers also help your body absorb non-heme iron more effectively
- Folate can be found in dark green vegetables, whole grains, beans, lentils and chickpeas
Energy Conservation
Grocery shopping, meal preparation and clean up are tasks that require a great deal of energy but are essential to ensuring you get the energy and nutrients you need. Here are some ways that you can help save energy on these tasks.
Grocery Shopping
- Check if your grocery store offers delivery services
- Look online for services where you can order online and have your groceries delivered to you
- Organize your grocery list by aisle
- Shop at less busy times to make your shopping trip quicker
- Buy only what you can easily carry and bring a wheeled cart to reduce heavy lifting
Preparing Meals
- Try vegetables and fruit that are already chopped (be sure to rinse them under running water before using)
- Buy frozen vegetables for quick steaming or stir fry dishes. They’re already washed, chopped and ready to use which can save you lots of time and energy
- Stock your fridge and pantry with quick options you can use to create nutritious meals with minimal effort. Examples include eggs, Greek yogurt and cheese, whole grain bread, whole grain pasta and couscous, cereal, oatmeal, crackers, canned fish, canned beans and frozen options
- Prepare food while sitting at a table rather than standing
- Use tools like a food processor as an alternative to cutting food by hand
- Use a crockpot or pressure cooker so you don’t have to stand over the stove
- Any time you’re cooking, make extras that can be frozen and quickly reheated when you don’t have the energy to cook
- Have a list of healthy delivery options in case you don’t have anything in the house to make quickly
Cleaning Up
- Choose recipes for one-pot meals like casseroles and stews so you only have one pot to clean
- Line baking sheets and roasting pans with parchment paper for less mess and scrubbing of pans
- Use a dishwasher if you have one
- Let dishes air dry in a drying rack instead of drying by hand
- Use biodegradable plates and utensils when you are too tired to wash dishes
Bio: Christy Brissette, MSc, RD is a registered dietitian and nutrition communications expert specializing in cancer survivorship. She is the President of 80 Twenty Nutrition, a nutrition and food media and consulting company. Christy is a TV personality, spokesperson, writer and blogger and is regularly interviewed by the media about nutrition and health.
